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#CGAJC. Thanks Pete for the question. Though the % of patients with a rash was high (80%), they were all Grade 1 and 2. They could be treated with steroid cream and oral clindmycyin (since the rash is believe to have a bacterial component). #CGA x.com/DocStanich/sta…

Also remember that oncology patients on erlotinib are on nearly 5 times the dose of this drug. Current clinical trial through NCI is using a lower dose of erlotinib (50mg) to see if better tolerability. #CGAjc x.com/DocStanich/sta…

The rash does focus on sun exposed areas, thus we tell them to use sun protection. A few patients we have treated clinically with 50mg per day have had almost no rash and use steroid cream prn. #CGAjc x.com/CGAIGC/status/…

There are alot of exciting trials in FAP starting or ongoing. 1) NCI trial of low dose erltoinib running at 7 centers. 2) DFMO-Sulindac trial wrapping up, results will be ready for DDW in 2019. 3) Upcoming pharma trials also in works. #CGAjc x.com/gcleslieb/stat…

Let me ask the group what do they do with a patient with Spigelman 3 duodenal disease? Surveillance, APC therapy, EMR? Nothing works well for these patients. Consider drug therapy? #CGAjc x.com/J_Samadder/sta…

Great question. Hopefully some GI docs can chime in. Problem is that endoscopic therapies including EMR, ESD, APC are all limited and potentially hazardous in causing a perforation. Chemoprevention is the future. #CGAjc x.com/gcleslieb/stat…

Anyone can prescribe erlotinib, as it is an oral chemotherapy. I have always used an oncology partner to prescribe/monitor these patients with me as they have the nursing resources to follow the patients. Would dose at 50 per day with sulindac.#CGAjc x.com/DocStanich/sta…

If a drug were to shrink polyps and downstage the patient, benefit is to avoid a Whipple or need for aggressive endoscopy procedures such as EMR. These have significant morbidity. #CGAjc x.com/RachelP_LGC/st…

If erltotinib can regress rectal polyps, in patient with large polyp burden could decrease need for rectal/pouch revision surgery. Big win for patients. #CGAjc x.com/J_Samadder/sta…

Insurance is the sticking point. I got two patients covered by sending them through Oncology who prescribed the drug. The other option is the NCI clinical trial ongoing which pays for the drugs. #CGAjc x.com/SoniaKupfer/st…

At the baseline endoscopy we only sampled one polyp to confirm Spigelman stage which requires histology. Otherwise leave polyps in place for 6 months to monitor effect of the drug. #CGAjc x.com/DocStanich/sta…

idiopathic pulmonary fibrosis is a very rare complication of erlotinib. Case reportable almost. We did not see any in our trial. Would not worry about IPF in practice, rash is day to day issue. #CGAjc x.com/SoniaKupfer/st…

Eventually covered in two patients where we were considering Whipple. Insurance seemed to favor erltonib over Whipple. #CGAjc x.com/DocStanich/sta…

Still to be answered. Most patients have stayed on the medication (erlotinib + sulindac) for at least 6-12 months. #CGAjc x.com/eve_karloski/s…

That would be ideal. We are planning to recuit 50 patients and have just started as of January 2018. 3 patients enrolled so far. Likely at least 12-18 months away from completion. #CGAjc x.com/SoniaKupfer/st…

Personally I think important to combine with COX inhibition (ie. sulindac). The new trial is testing if erlotinib alone is effective at a lower dose (50mg per day). The data will show the answer. #CGAjc x.com/SoniaKupfer/st…

Centers participating include: Mayo Arizona, Mayo Rochester, U Utah, MD Anderson, Cleveland Clinic, U Pitt, U Michigan, Peurto Rico. #CGAjc x.com/SoniaKupfer/st…

Broad inclusion: clinical or genetic FAP, >18 yo, 5years out from cancer, Spigelman stage 1, 2, 3 duodenal disease, #CGAjc x.com/SoniaKupfer/st…

Here is the trials.gov website. cancer.gov/about-cancer/t… #CGAjc x.com/SoniaKupfer/st…

#CGAjc Thank you everyone for participating. I know we are all working together to better the lives of our hereditary cancer patients. Medical trials will be an important option to consider for our patients. x.com/SoniaKupfer/st…